JP2003501130A5 - - Google Patents
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- JP2003501130A5 JP2003501130A5 JP2001501114A JP2001501114A JP2003501130A5 JP 2003501130 A5 JP2003501130 A5 JP 2003501130A5 JP 2001501114 A JP2001501114 A JP 2001501114A JP 2001501114 A JP2001501114 A JP 2001501114A JP 2003501130 A5 JP2003501130 A5 JP 2003501130A5
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- flow path
- suction
- suction flow
- treatment site
- flexible
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- 239000012530 fluid Substances 0.000 description 7
- 210000002216 Heart Anatomy 0.000 description 5
- 238000004891 communication Methods 0.000 description 5
- 238000010009 beating Methods 0.000 description 4
- 239000003365 glass fiber Substances 0.000 description 3
- 210000004351 Coronary Vessels Anatomy 0.000 description 2
- 229920001971 elastomer Polymers 0.000 description 2
- 239000000806 elastomer Substances 0.000 description 2
- XEEYBQQBJWHFJM-UHFFFAOYSA-N iron Chemical compound [Fe] XEEYBQQBJWHFJM-UHFFFAOYSA-N 0.000 description 2
- 238000000034 method Methods 0.000 description 2
- 230000003287 optical Effects 0.000 description 2
- 210000000056 organs Anatomy 0.000 description 2
- 229920000642 polymer Polymers 0.000 description 2
- 238000011105 stabilization Methods 0.000 description 2
- 239000003381 stabilizer Substances 0.000 description 2
- 230000000087 stabilizing Effects 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 210000003238 Esophagus Anatomy 0.000 description 1
- 210000000232 Gallbladder Anatomy 0.000 description 1
- 206010018987 Haemorrhage Diseases 0.000 description 1
- 210000000936 Intestines Anatomy 0.000 description 1
- 210000003734 Kidney Anatomy 0.000 description 1
- 210000004185 Liver Anatomy 0.000 description 1
- 210000004072 Lung Anatomy 0.000 description 1
- 210000002784 Stomach Anatomy 0.000 description 1
- 210000000779 Thoracic Wall Anatomy 0.000 description 1
- 230000003213 activating Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000000740 bleeding Effects 0.000 description 1
- 231100000319 bleeding Toxicity 0.000 description 1
- JOYRKODLDBILNP-UHFFFAOYSA-N ethyl urethane Chemical compound CCOC(N)=O JOYRKODLDBILNP-UHFFFAOYSA-N 0.000 description 1
- 238000005755 formation reaction Methods 0.000 description 1
- 229910052742 iron Inorganic materials 0.000 description 1
- 229920001296 polysiloxane Polymers 0.000 description 1
- 238000002432 robotic surgery Methods 0.000 description 1
- 238000004804 winding Methods 0.000 description 1
Description
【特許請求の範囲】
【請求項１】 患者の体腔内の治療部位の表面を安定化させる装置であって、
近位端と、遠位先端に可撓性部分を有する遠位端とを有し、患者の体腔に進入できる寸法および構造にされた細長い中空ロッドと、
ロッドの可撓性部分と、ロッドの可撓性部分をリング状または蹄鉄状に巻くためにロッドの近位端に結合された操縦機構とに取り付けられた、中空ロッド内のたわみ機構と、
巻くことのできる細長い吸入流路であって、
可撓性の先端の一方の側に沿って取り付けられた細長い基部と、
基部の可撓性の先端への取付け部の反対側で基部の周囲を囲む可撓性リムと、
離れた位置にある真空源から部分真空と流体連通する吸入流路の１つまたは複数の吸入口と、
を備える吸入流路とを備え、
操縦装置を作動させることによって、吸入流路がリング状または蹄鉄状に巻かれる装置。
【請求項２】 リムの、リング状または蹄鉄状の外周を形成する基部の側に沿って取り付けられた部分が、広がっておりさらに広げることができる、請求項１に記載の装置。
【請求項３】 巻かれた吸入流路がロッドに対して斜めの平面内に位置する、請求項１に記載の装置。
【請求項４】 吸入流路のリング形状または蹄鉄形状によって形成される開口部が、治療部位にある吻合部位に冠状動脈バイパス・グラフトを該開口部を通して外科的に取り付けることができる寸法とされている、請求項１に記載の装置。
【請求項５】 開口部が実質的に円形である、請求項４に記載の装置。
【請求項６】 開口部の直径が約１mmから約２５mmの範囲である、請求項５に記載の装置。
【請求項７】 開口部の直径が約１５mmから約２０mmの範囲である、請求項５に記載の装置。
【請求項８】 開口部が楕円形である、請求項４に記載の装置。
【請求項９】 楕円形開口部の短軸が約１mmから約２０mmの範囲であり、楕円形開口部の長軸が約５mmから約２５mmの範囲である、請求項８に記載の装置。
【請求項１０】 吸入流路が蹄鉄状に巻かれる、請求項１に記載の装置。
【請求項１１】 リムの前記部分の厚さが、基部への取付け点からリムの先端へと徐々に変化し、基部からリムの前記部分の先端までの垂直距離が、基部からリムの他の部分の先端までの距離よりも長い、請求項２に記載の装置。
【請求項１２】 リムの該部分の先端が、吸入流路が治療部位に接触している間に吸入流路に部分真空を付与したときに、リムの該部分が平坦になり、外側に治療部位の表面を横切って広がるのに十分な可撓性を有する、請求項２に記載の装置。
【請求項１３】 吸入流路の吸入フィールドが、約０.１cm２から約１０cm２の範囲の面積を有する、請求項１に記載の装置。
【請求項１４】 吸入流路の吸入フィールドが、約３.５cm２から約６cm２の範囲の面積を有する、請求項１３に記載の装置。
【請求項１５】 吸入流路がエラストマ・ポリマーから製造される、請求項１に記載の装置。
【請求項１６】 エラストマ・ポリマーがシリコンまたはウレタンである、請求項１５に記載の装置。
【請求項１７】 吸入流路が実質的に透明である、請求項１５に記載の装置。
【請求項１８】 ロッドの可撓性部分が細長い高分子スリーブで覆われ、吸入流路の基部が、スリーブに沿った取付けによってロッドに取り付けられる、請求項１５に記載の装置。
【請求項１９】 ロッドの可撓性部分が関節結合されている、請求項１に記載の装置。
【請求項２０】 たわみ機構が、中空ロッド内で遠位端から操縦機構まで延びるたわみワイヤからなる、請求項１に記載の装置。
【請求項２１】 操縦機構が、可撓性部分を巻きかつ解くようになされたスライド、クランク、トリガ、または回転可能なハンドルである、請求項１に記載の装置。
【請求項２２】 ロッドの外側の近位部に位置する１つまたは複数のガス・ポートと流体連通すると共に、吸入流路のリング形状または蹄鉄形状によって画定される開口部にガスの流れを供給するようになされた１つまたは複数のガス・ポートと流体連通するガス管をさらに備える、請求項４に記載の装置。
【請求項２３】 装置が、吸入流路内の、間隔を置いて配置された位置に、少なくとも３つの吸入口を備え、該吸入口が吸入管と流体連通している、請求項１に記載の装置。
【請求項２４】 吸入流路が、隣接する領域よりも高い部分真空を有する一連の局部領域を作る形状とされている、請求項１に記載の装置。
【請求項２５】 吸入流路が起伏を有する（contoured）、請求項１に記載の装置。
【請求項２６】 光源と光学的に連絡する光ファイバと、該光ファイバと光学的に連絡する光ポートとをさらに備え、前記光ポートが、それから送られた光が開口部の内部の治療部位を照明するようにロッドまたは吸入流路の可撓性部分に沿って位置している、請求項４に記載の装置。
【請求項２７】 光ファイバが中空ロッド内に含まれている、請求項２５に記載の装置。
【請求項２８】 必要に応じて患者の治療部位を内視鏡によって安定化させる方法において使用するための請求項１に記載の装置であって、
細長い構成の、請求項１による安定化装置の可撓性の先端を、患者の体腔に進入させる工程と、
近位の操縦機構を作動させ細長い先端を体腔内でリング状または蹄鉄状に巻く工程と、
巻かれた吸入流路が治療部位の表面に押し付けられるように細長いロッドの近位部を保持する工程と、
吸入流路を治療部位に付着させるのに十分な部分真空を吸入口を介して吸入流路に付与し、それによって、治療部位を安定化させる工程と、からなる方法において使用するための装置。
【請求項２９】 リムの、リング形状または蹄鉄形状の外周を形成する基部の部分に沿って取り付けられた部分が、広がっておりさらに広げることができ、リムの前記部分が、吸入流路内に部分真空が確立されたときに平坦になり外側に広がる、請求項２８に記載の装置。
【請求項３０】 内視鏡部位スタビライザの進入が、患者の体に外科的に形成された開口部を介して行われる、請求項２８に記載の装置。
【請求項３１】 ロッドの近位部を外部の物体に一時的に取り付けることをさらに含む、請求項２８に記載の装置。
【請求項３２】 安定化が、体腔内の治療部位の表面に張力をかけることを含む、請求項２８に記載の装置。
【請求項３３】 部分真空を付与すると、リング状または蹄鉄状の吸入流路によって画定される開口部を通して治療部位が部分的に押し出される、請求項２８に記載の装置。
【請求項３４】 治療部位が、鼓動する心臓の表面上の冠状動脈の吻合部位であり、安定化が、バイパス手術の間、鼓動する心臓上の治療部位の動きを大幅に低減させることを含む、請求項２８に記載の装置。
【請求項３５】 鼓動する心臓の表面が、ロボット手術の間安定化する、請求項３４に記載の装置。
【請求項３６】 治療部位が、鼓動する心臓の前側に位置する、請求項３４に記載の装置。
【請求項３７】 バイパス手術が、胸壁を開かずに、胸腔鏡で観察しながら行われる、請求項３４に記載の装置。
【請求項３８】 操縦機構が手動で作動させられる、請求項２８に記載の装置。
【請求項３９】 装置が、ガス供給源と、巻かれた吸入流路によって画定される開口部に圧縮ガスの流れを供給するようになされた１つまたは複数のガス・ポートとの間を流体連通させる圧縮ガス管をさらに備える、請求項２８に記載の装置。
【請求項４０】 巻かれた吸入流路が、治療部位に取付けられている間、該吸入流路によって画定される開口部を通して治療部位を外科的に操作できるようにする寸法とされている、請求項３３に記載の装置。
【請求項４１】 吸入流路が、約０.１cm２から約１０cm２の範囲の表面積にわたって部分真空を付与する、請求項２８に記載の装置。
【請求項４２】 治療部位の表面上の局部的な吸入出血の形成が最小限に抑えられる、請求項２８に記載の装置。
【請求項４３】 治療部位が内臓の表面上に位置している、請求項２８に記載の装置。
【請求項４４】 内臓が、患者の心臓、胃、食道、胆嚢、肝臓、腸、腎臓、または肺である、請求項４３に記載の装置。
【請求項４５】 巻くことのできる可撓性の吸入体であって、
細長いが巻くことのできる吸入流路を備え、前記吸入流路が、
細長い基部と、
基部の周囲を囲む可撓性のリムと、
可撓性のリムの反対側で基部の周囲に沿って取り付けられており、操縦可能なカテーテルの可撓性の先端を受容する開口部を一端に有する、可撓性の細長いスリーブと、
吸入流路内に部分真空を確立する１つまたは複数の吸入口と、
少なくとも１つまたは複数の吸入口と流体連通する可撓性の管とを備え、
吸入流路の完全性を失わずに吸入体をリング状または蹄鉄状に巻くことができる吸入体。
【請求項４６】 吸入流路の外側に沿って位置する１つまたは複数のガス・ポートと、１つまたは複数のガス・ポートと流体連通する第２の管とをさらに備える、請求項４５に記載の吸入体。
【請求項４７】 リムが、吸入流路に沿って一連の領域を形成するように、吸入流路の内側に沿って形作られており、治療部位への取付け時に形成される部分真空が、隣接する領域よりも高い、請求項４５に記載の吸入体。
【請求項４８】 内側リム部分が広がっておりさらに広げることができる、請求項４５に記載の吸入体。
[Claims]
1. A device for stabilizing the surface of a treatment site in a patient's body cavity.
An elongated hollow rod sized and structured to enter the patient's body cavity, with a proximal end and a distal end with a flexible portion at the distal tip.
A flexing mechanism within a hollow rod attached to a flexible portion of the rod and a maneuvering mechanism coupled to the proximal end of the rod to wind the flexible portion of the rod in a ring or horseshoe.
It is an elongated suction flow path that can be rolled up.
With an elongated base attached along one side of the flexible tip,
With a flexible rim that surrounds the base on the opposite side of the base's flexible tip attachment
With one or more suction ports in the suction flow path that communicate the fluid with the partial vacuum from the distant vacuum source.
With a suction flow path and
A device in which the suction flow path is wound in a ring shape or a horseshoe shape by operating the control device.
2. The device of claim 1, wherein a portion of the rim attached along the side of the base that forms a ring-shaped or horseshoe-shaped outer circumference is widened and can be further widened.
3. The device according to claim 1, wherein the wound suction flow path is located in a plane oblique to the rod.
4. The opening formed by the ring shape or horseshoe shape of the inhalation flow path is sized so that a coronary artery bypass graft can be surgically attached to the anastomotic site at the treatment site through the opening. The device according to claim 1.
5. The apparatus of claim 4, wherein the opening is substantially circular.
6. The apparatus according to claim 5, wherein the diameter of the opening is in the range of about 1 mm to about 25 mm.
7. The apparatus according to claim 5, wherein the diameter of the opening is in the range of about 15 mm to about 20 mm.
8. The apparatus according to claim 4, wherein the opening is elliptical.
9. The apparatus according to claim 8, wherein the short axis of the elliptical opening is in the range of about 1 mm to about 20 mm, and the long axis of the elliptical opening is in the range of about 5 mm to about 25 mm.
10. The device according to claim 1, wherein the suction flow path is wound like a horseshoe.
11. The thickness of the portion of the rim gradually changes from the attachment point to the base to the tip of the rim, and the vertical distance from the base to the tip of the portion of the rim is from the base to the other tip of the rim. The device according to claim 2, which is longer than the distance to the tip of the portion.
12. When the tip of the portion of the rim applies partial vacuum to the suction channel while the suction channel is in contact with the treatment site, the portion of the rim becomes flat and treated outward. The device of claim 2, which is flexible enough to spread across the surface of the site.
13. The apparatus of claim 1, wherein the suction field of the suction flow path has an area in the range of about 0.1 cm 2 to about 10 cm 2.
14. The apparatus of claim 13, wherein the suction field of the suction channel has an area in the range of about 3.5 cm 2 to about 6 cm 2.
15. The apparatus of claim 1, wherein the suction channel is made of an elastomer polymer.
16. The apparatus of claim 15, wherein the elastomer polymer is silicone or urethane.
17. The device of claim 15, wherein the suction flow path is substantially transparent.
18. The device of claim 15, wherein the flexible portion of the rod is covered with an elongated polymeric sleeve and the base of the suction flow path is attached to the rod by attachment along the sleeve.
19. The device of claim 1, wherein the flexible portion of the rod is articulated.
20. The device of claim 1, wherein the deflection mechanism comprises a deflection wire extending from a distal end to the control mechanism in a hollow rod.
21. The device of claim 1, wherein the maneuvering mechanism is a slide, crank, trigger, or rotatable handle that winds and unwinds a flexible portion.
22. A fluid communication with one or more gas ports located proximal to the outside of the rod and supply of gas flow to an opening defined by a ring or foot iron shape of the suction channel. The device of claim 4, further comprising a gas pipe that communicates fluid with one or more gas ports made to do so.
23. The first aspect of the present invention, wherein the device is provided with at least three suction ports at spaced positions in the suction flow path, and the suction ports are in fluid communication with the suction pipe. Equipment.
24. The apparatus of claim 1, wherein the suction flow path is shaped to form a series of local regions having a partial vacuum higher than the adjacent regions.
25. The apparatus according to claim 1, wherein the suction flow path is contoured.
26. An optical fiber that optically communicates with a light source and an optical port that optically communicates with the optical fiber are further provided, and the light transmitted from the optical port is a treatment site inside an opening. The device of claim 4, which is located along a flexible portion of a rod or suction flow path to illuminate.
27. The apparatus of claim 25, wherein the optical fiber is contained within a hollow rod.
28. The apparatus according to claim 1, wherein the device is used in a method of stabilizing a patient's treatment site with an endoscope as needed.
A step of allowing the flexible tip of the stabilizer according to claim 1 having an elongated structure to enter the body cavity of the patient.
The process of activating the proximal maneuvering mechanism and winding the elongated tip in a ring or horseshoe in the body cavity,
The process of holding the proximal part of the elongated rod so that the wound suction channel is pressed against the surface of the treatment area,
A device for use in a method comprising the steps of providing a partial vacuum to the suction flow path through the suction port to stabilize the treatment site, thereby providing a partial vacuum sufficient to attach the suction flow path to the treatment site.
29. A portion of the rim that is attached along a portion of the base that forms a ring-shaped or horseshoe-shaped outer circumference is widened and can be further widened so that the portion of the rim is in the suction flow path. 28. The device of claim 28, which flattens and spreads outward when a partial vacuum is established.
30. The device of claim 28, wherein the endoscopic site stabilizer is entered through an opening surgically formed in the patient's body.
31. The device of claim 28, further comprising temporarily attaching a proximal portion of the rod to an external object.
32. stabilization comprises applying tension to the surface of a treatment site in a body cavity, according to claim 28.
33. The device of claim 28, wherein when a partial vacuum is applied, the treatment site is partially extruded through an opening defined by a ring-shaped or horseshoe-shaped suction flow path.
34. The treatment site is an anastomotic site of a coronary artery on the surface of the beating heart, and stabilization comprises significantly reducing the movement of the beating heart treatment site during bypass surgery. 28. The apparatus of claim 28.
35. The device of claim 34, wherein the surface of the beating heart stabilizes during robotic surgery.
36. The device of claim 34, wherein the treatment site is located anterior to the beating heart.
37. The device of claim 34, wherein the bypass surgery is performed while observing with a thoracoscope without opening the chest wall.
38. The device of claim 28, wherein the maneuvering mechanism is manually actuated.
39. A fluid between a gas source and one or more gas ports adapted to supply a flow of compressed gas to an opening defined by a wound suction flow path. 28. The apparatus of claim 28, further comprising a compressed gas pipe for communication.
40. The wound suction flow path is sized to allow the treatment site to be surgically manipulated through an opening defined by the suction flow path while attached to the treatment site. The device according to claim 33.
41. A suction channel imparts a partial vacuum over a surface area in the range of from about 0.1 cm 2 to about 10 cm 2, apparatus according to claim 28.
42. The device of claim 28, wherein the formation of localized inhalation bleeding on the surface of the treatment site is minimized.
43. The device of claim 28, wherein the treatment site is located on the surface of an internal organ.
44. The device of claim 43, wherein the internal organs are the patient's heart, stomach, esophagus, gallbladder, liver, intestines, kidneys, or lungs.
45. A flexible inhaler that can be rolled up.
An elongated suction flow path is provided, and the suction flow path is
With an elongated base
With a flexible rim that surrounds the base
A flexible elongated sleeve that is mounted along the perimeter of the base on the opposite side of the flexible rim and has an opening at one end that receives the flexible tip of the maneuverable catheter.
With one or more suction ports establishing a partial vacuum in the suction flow path,
Provided with at least one or more suction ports and a flexible tube for fluid communication.
An inhaler that allows the inhaler to be wound in a ring or horseshoe without losing the integrity of the inhalation flow path.
46. Claim 45 further comprises one or more gas ports located along the outside of the suction flow path and a second tube for fluid communication with the one or more gas ports. The inhaler described.
47. The rim is shaped along the inside of the suction flow path so that it forms a series of regions along the suction flow path, with the partial vacuum formed upon attachment to the treatment site adjacent. The inhaler according to claim 45, which is higher than the area to be used.
48. The inhaler according to claim 45, wherein the inner rim portion is widened and can be further widened.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US09/328,526 US6231585B1 (en) | 1997-11-20 | 1999-06-09 | Device for stabilizing a treatment site and method of use |
| US09/328,526 | 1999-06-09 | ||
| PCT/US2000/014669 WO2000074574A1 (en) | 1999-06-09 | 2000-05-26 | Device for stabilizing a treatment site and method of use |
Publications (3)
| Publication Number | Publication Date |
|---|---|
| JP2003501130A JP2003501130A (en) | 2003-01-14 |
| JP2003501130A5 true JP2003501130A5 (en) | 2007-06-28 |
| JP4130077B2 JP4130077B2 (en) | 2008-08-06 |
Family
ID=23281342
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2001501114A Expired - Fee Related JP4130077B2 (en) | 1999-06-09 | 2000-05-26 | Apparatus and method for stabilizing a treatment site |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US6231585B1 (en) |
| EP (1) | EP1189538B1 (en) |
| JP (1) | JP4130077B2 (en) |
| AT (1) | ATE287664T1 (en) |
| CA (1) | CA2375305A1 (en) |
| DE (1) | DE60017734T2 (en) |
| ES (1) | ES2235901T3 (en) |
| WO (1) | WO2000074574A1 (en) |
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- 2000-05-26 CA CA002375305A patent/CA2375305A1/en not_active Abandoned
- 2000-05-26 JP JP2001501114A patent/JP4130077B2/en not_active Expired - Fee Related
- 2000-05-26 AT AT00942645T patent/ATE287664T1/en not_active IP Right Cessation
- 2000-05-26 DE DE60017734T patent/DE60017734T2/en not_active Expired - Fee Related
- 2000-05-26 WO PCT/US2000/014669 patent/WO2000074574A1/en active IP Right Grant
- 2000-05-26 EP EP00942645A patent/EP1189538B1/en not_active Expired - Lifetime
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